Provider Demographics
NPI:1508599135
Name:SPC NUTRITION COACHING, LLC
Entity Type:Organization
Organization Name:SPC NUTRITION COACHING, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:RDN
Authorized Official - Phone:203-272-4797
Mailing Address - Street 1:555 HIGHLAND AVE STE 25
Mailing Address - Street 2:
Mailing Address - City:CHESHIRE
Mailing Address - State:CT
Mailing Address - Zip Code:06410-2255
Mailing Address - Country:US
Mailing Address - Phone:203-272-4797
Mailing Address - Fax:866-252-5773
Practice Address - Street 1:555 HIGHLAND AVE # 25
Practice Address - Street 2:
Practice Address - City:CHESHIRE
Practice Address - State:CT
Practice Address - Zip Code:06410-2255
Practice Address - Country:US
Practice Address - Phone:203-272-4797
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-07-01
Last Update Date:2022-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty